益气养阴活血汤联合阿托伐他汀治疗气阴两虚兼血瘀型早期糖尿病肾病效果分析贺学允, 等 811 Keywords 2013 to December 2014 in the hospital, the patients were randomly divided into treatment group

Size: px

Start display at page:

Download "益气养阴活血汤联合阿托伐他汀治疗气阴两虚兼血瘀型早期糖尿病肾病效果分析贺学允, 等 811 Keywords 2013 to December 2014 in the hospital, the patients were randomly divided into treatment group"

庸世
5 years ago
Views:

1 810 临床与病理杂志 J Clin Pathol Res 2016, 36(6) doi: /j.issn View this article at: 益气养阴活血汤联合阿托伐他汀治疗气阴两虚兼血瘀型早期糖尿病肾病效果分析贺学允 1 2, 陈玉玲 (1. 商洛市中心医院内分泌科, 陕西商洛 ;2. 商洛市疾病预防控制中心, 陕西商洛 ) [ 摘要 ] 目的 : 分析益气养阴活血汤联合阿托伐他汀治疗气阴两虚兼血瘀型早期糖尿病肾病的效果方法 : 选择 2013 年 1 月至 2014 年 12 月在医院就诊的气阴两虚兼血瘀型早期糖尿病肾病患者 80 例, 按照随机数表法分为治疗组和对照组, 各 40 例, 对照组患者给予阿托伐他汀治疗, 治疗组在对照组的基础上给予益气养阴活血汤治疗, 治疗前后, 抽取患者的静脉血, 检测其 C 反应蛋白 (CRP) 糖化血红蛋白 (HbAlc) 血浆同型半胱氨酸(HCY) 水平 ; 评定患者的治疗效果 ; 检测两组患者的尿微量蛋白排泄率 (UAER) 24 h 蛋白尿排泄率 (24hUAE) 血肌酐(Scr) 24 h 尿蛋白定量 (24hUPQ) 尿素氮 (BUN) 水平结果 : 治疗后, 治疗组的 CRP HbAlc HCY UAER 24hUAE Scr 24hUPQ 水平显著低于对照组, 差异有统计学意义 (P<0.05); 两组 TC TG LDL-C 均较治疗前降低,HDL-C 较治疗前升高, 且治疗组较对照组显著, 差异有统计学意义 ( P <0.05); 治疗组患者有效率为 87.50%, 对照组患者治疗有效率为 65.00%, 显著低于治疗组, 差异有统计学意义 (P<0.05); 两组患者不良反应比较差异无统计学意义 (P>0.05) 结论: 益气养阴活血汤联合阿托伐他汀联合作用, 可以降脂降糖滋阴补肾活血化瘀, 有效延缓气阴两虚兼血瘀型早期糖尿病的病情进展 [ 关键词 ] 益气养阴活血汤 ; 阿托伐他汀 ; 气阴两虚 ; 血瘀型早期糖尿病肾病 Analysis of the effect of Yiqiyangyinhuoxue decoction combined with atorvastatin statin treatment of early diabetic nephropathy with Qi and Yin deficiency and blood stasis type HE Xueyun 1, CHEN Yuling 2 (1. Department of Endocrinology, Shangluo City Center Hospital, Shangluo Shaanxi ; 2. Shangluo City Disease Control and Prevention Center, Shangluo Shaaxi , China) Abstract Objective: To analyze the effect of Yiqiyangyinhuoxue decoction combined with atorvastatin on statin treatment of blood stasis type early diabetic nephropathy with the deficiency of both Qi and Yin. Methods: A total of 80 cases of blood stasis type early diabetic nephropathy with Qi and Yin deficiency were selected from January 收稿日期 (Date of reception): 通信作者 (Corresponding author): 贺学允, HXY197403@163.com

2 益气养阴活血汤联合阿托伐他汀治疗气阴两虚兼血瘀型早期糖尿病肾病效果分析贺学允, 等 811 Keywords 2013 to December 2014 in the hospital, the patients were randomly divided into treatment group and control group, each of 40 cases. The control group was treated with atorvastatin treatment, and the treatment group plus Yiqiyangyinhuoxue decoction treatment on the basis of the control group. Before and after treatment, detected the level of C reactive protein (CRP), glycosylated hemoglobin (HbAlc), and plasma homocysteine (HCY) in venous blood samples of patients; evaluated the effect of the treatment; detected the level of urinary albumin excretion rate (UAER), 24-h urinary protein excretion rate (24hUAE), serum creatinine (Scr), 24-h urinary protein (24hUPQ), urea nitrogen (BUN) in the two groups. Results: After treatment, the level of CRP, HbA1c, HCY, UAER, 24hUAE, SCR, 24hUPQ in the treatment group was lower than that in the control group, the difference was statistically significant (P<0.05); the level of TC, TG, LDL-C in both groups was lower than those before treatment; HDL-C level was higher than that before treatment, and the difference between the two groups was statistically significant (P<0.05). The effective rate in the treatment group was 87.50%, while in the control groups the rate was 65.00%, which was significantly lower than that in the treatment group (P<0.05); comparison of adverse reactions of the two groups has no statistical significance (P>0.05). Conclusion: Yiqiyangyinhuoxue decoction combined with atorvastatin cutting statins has the effects of lipid-lowering and hypoglycemic, enriching yin and nourishing kidney, promoting blood circulation, and further effectively delays the progression of early diabetes with Qi and Yin deficiency and blood stasis. Yiqiyangyinhuoxue decoction; atovatatin; Qi and Yin deficiency; blood stasis syndrome of early diabetic nephropathy 糖尿病肾病是糖尿病常见的并发症, 也是慢性肾衰竭的重要因素主要特点是病情演变较为复杂, 病程长等 [1] 目前临床多采用西医治疗, 西医治疗多本着降糖降脂控制饮食降压等原则, 虽然能够在一定程度上缓解糖尿病肾病的病情进展, 但是效果并不令人满意 [2] 随着中医学在临床中的广泛应用, 其在早期糖尿病肾病的治疗中取得较好效果, 尤其是在气阴两虚兼血瘀型早期糖尿病肾病中的应用 [3] 本次研究主要研究益气养阴活血汤联合阿托伐他汀在气阴两虚兼血瘀型早期糖尿病肾病中的应用效果, 现具体报道如下 1 资料与方法 1.1 一般资料选择 2013 年 1 月至 2014 年 12 月在医院就诊的气阴两虚兼血瘀型早期糖尿病肾病患者 80 例, 所有患者均符合早期糖尿病肾病诊断标准 [4], 根据中药新药临床研究指导原则 [5] 判定标准, 所有患者均为气阴两虚兼血瘀型早期糖尿病肾病, 所有患者血压均在正常范围内按照随机数表法分为治疗组和对照组, 各 40 例治疗组患者中年龄 (66.38±4.59) 岁, 男 20 例, 女 20 例 ; 对照组中年龄 (65.38±4.30) 岁, 男 19 例, 女 21 例两组患者临床资料比较无差异所有患者均对本次研究知情, 且签署知情同意书, 此研究经我院伦理委员会批准 1.2 方法对两组患者均进行糖尿病宣传教育, 控制其饮食, 并鼓励患者进行适当的运动对照组患者给予阿托伐他汀治疗, 口服,10 mg/ 次,1 次 /d 治疗组在对照组的基础上给予益气养阴活血汤治疗, 药物成分 : 水蛭 3 g, 大黄 6 g, 生黄芪 30 g, 丹参熟地黄各 15 g, 黄柏山药赤芍药山茱萸各 10 g, 金樱子芡实各 12 g 若出现水肿则加猪苓车前子茯苓各 10 g, 若出现呕吐则加砂仁竹茹各 10 g 每日 1 剂, 水煎 2 次, 早晚各服用 1 次, 治疗时间为 3 个月 1.3 观察指标治疗前后, 抽取患者的静脉血, 检测其 C 反应蛋白 (CRP) 糖化血红蛋白(HbAlc) 血浆同型半胱氨酸 (HCY) 水平 ; 评定患者的治疗效果 : 无效 : 患者症状没有改善, 甚至加重 ; 有效 : 尿蛋白持续减少 50% 以上, 中医临床症状体征有所好转 ; 显效 :24 h 尿蛋白持续 <150 mg, 中医临床症状有明显改善 ; 检测两组患者的尿微量蛋白排泄率 (UAER) 24 h 蛋白尿排泄率 (24hUAE) 血肌酐(Scr) 24 h 尿蛋白定量 (24hUPQ) 尿素氮(BUN) 水平

3 812 临床与病理杂志, 2016, 36(6) 统计学处理采用 SPSS 19.0 对数据进行统计学处理, 计数资料用 χ 2 检验, 计量资料用 t 检验,P<0.05 统计学差异显著 2 结果 2.1 两组 CRP HbAlc HCY 水平比较治疗后, 治疗组的 CRP HbAlc HCY 水平低于对照组 (P<0.05), 见表 1 24hUPQ 水平均较对照组降低 (P<0.05), 见表两组治疗效果比较治疗组有效率为 87.50%, 高于对照组 65.00%(P<0.05), 见表两组患者血脂指标比较治疗后, 两组 TC TG LDL-C 均较治疗前降低,HDL-C 较治疗前升高, 且治疗组较对照组显著 (P<0.05), 见表两组患者 UAER 24hUAE Scr 24hUPQ 比较治疗后, 治疗组患者的 UAER 24hUAE Scr 2.5 两组患者不良反应比较治疗组患者出现 1 例恶心呕吐, 对照组出现 2 例恶心呕吐表 1 CRP HbAlc HCY 水平比较 Table 1 Comparison of CRP, HbAlc and HCY levels 组别 CRP/mg L 1 HbAlc/mmol L 1 HCY/mg L 1 治疗前治疗后治疗前治疗后治疗前治疗后治疗组 7.33± ± ± ± ± ±2.35 对照组 7.40± ± ± ± ± ±2.38 t P 表 2 UAER 24hUAE Scr 24hUPQ 比较 Table 2 Comparison of UAER, 24hUAE, Scr and 24hUPQ 组别时间 UAER/mg 24h 1 24hUAE/mg 24h 1 Scr/μmol L 1 24hUPQ/mg 24h 1 治疗组治疗前 ± ± ± ±13.44 治疗后 ±10.29* # ±10.27* # 92.39±5.39* # ±10.33* # 对照组治疗前 ± ± ± ±13.04 治疗后 ±11.02* ±10.56* 98.39±5.69* ±10.39* 与治疗前比较,*P<0.05; 与对照组比较, # P<0.05 Compared with before treatment, *P<0.05; compared with the control group, # P<0.05. 表 3 治疗效果比较 Table 3 Comparison of therapeutic effects 组别显效有效无效有效率 (%) 治疗组 (87.50) 对照组 (65.00) χ P 0.027

4 益气养阴活血汤联合阿托伐他汀治疗气阴两虚兼血瘀型早期糖尿病肾病效果分析贺学允, 等 813 表 4 两组患者血脂指标比较 Table 4 Comparison of serum lipid levels in two groups 组别时间 TG/mmol L -1 HDL-C/mmol L -1 LDL-C/mmol L -1 TC/mmol L -1 治疗组治疗前 2.88± ± ± ±1.02 治疗后 1.72±0.29* # 2.63±0.46* # 1.38±0.21* # 3.10±1.01* # 对照组治疗前 2.87± ± ± ±1.10 治疗后 1.95±0.32* 3.02±0.28* 1.24± ±1.14* 与治疗前比较,*P<0.05; 与对照组比较, # P<0.05 Compared with before treatment, *P<0.05; compared with the control group, # P< 讨论糖尿病肾病是糖尿病常见并发症, 也是较为难 [6] 治的微血管并发症有关研究指出, 终末期肾衰竭患者约 40% 是由糖尿病肾病导致的一旦糖尿病患者出现持续性蛋白尿, 多数都会进展为肾功能衰竭目前多采用他汀类药物治疗早期糖尿病肾病, 如阿托伐他汀但是阿托伐他汀对糖尿病肾病的病情进展的治疗效果有限中医药在糖尿病肾病中大量应用并取得较好的治疗效果 [7] 中医将糖尿肾病归属水肿关格等范畴, 分为阴虚热盛气阴两虚阴阳两虚兼血瘀证非血瘀证 [8] 有关研 [9-10] 究指出, 气阴两虚兼血瘀证糖尿病肾病患者较其 [10-11] 他类型有较高的 UAER 水平有关研究者收集糖尿病肾病临床证候学资料, 分析发现, 糖尿病肾病病机从早期到临床呈现气阴两虚发展向阴阳两虚的趋势, 并有加重的趋势, 病情持续进展, 则肾气衰惫, 气血俱伤, 血脉瘀阻, 三焦阻滞, 进而出现水肿涨满尿浊关格等一系列症状, 气阴两虚是早期糖尿病的主要病机因此, 对于呈现气阴两虚兼血瘀型的早期糖尿病肾病患者需要给予及时的治疗, 防止病情进一步发展中药可以抑制低度炎症反应, 进而延缓肾脏损伤的进展 HCY 含量过高是导致微血管病变的独立危险因素, 与糖尿病肾病的病情进展有一定的关系 [12] 本次研究结果显示, 治疗组的 CRP HbAlc HCY 水平显著低于对照组益气养阴活血汤中, 丹参水蛭赤芍药具有通络活血化瘀的功效, 联合西药的降压降脂降糖作用, 中西结合, 相得益彰, 有效降低患者的 CRP HbAlc HCY 水平, 进而减缓病情的进展本次研究结果显示, 治疗组患者的 UAER 24hUAE Scr 24hUPQ 水平均较对照组降低生黄芪有补脾益气的功效, 山药熟地黄具有滋阴补肾的功效, 金樱子固精缩尿, 芡实补肾固精, 补肾效果较好另外, 阿托伐他汀具有改善内皮功能, 抗炎等效果, 与益气养阴活血汤联合作用, 改善患者的肾功能, 进而降低 UAER 24hUAE Scr 24hUPQ 水平本次研究结果显示, 两组 TC TG LDL-C 均较治疗前降低,HDL-C 较治疗前升高, 且治疗组较对照组显著该结果显示, 益气养阴活血汤联合阿托伐他汀能够显著降低患者的血糖血脂水平主要是因为, 益气养阴活血汤中诸药联合作用, 补肾, 活血化瘀, 防止微血管病变本次研究指出, 治疗组患者的治疗有效率显著高于对照组, 该结果也证实了, 益气养阴活血汤联合阿托伐他汀, 中西结合, 相得益彰, 有效提高早期糖尿病肾病的治疗效果, 且具有较好的安全性综上所述, 益气养阴活血汤联合阿托伐他汀联合作用, 可降脂降糖, 滋阴补肾活血化瘀, 有效延缓气阴两虚兼血瘀型早期糖尿病的病情进展参考文献 1. 闰玲, 侯建芳. 中西医结合治疗早期糖尿病肾病临床观察 [ J]. 中国中医急症, 2014, 23(5): RUN Ling, HOU Jianfang. Clinical observation on early diabetic nephropathy treated with integrated traditional Chinese and Western Medicine[ J]. Journal of Emergency in Traditional Chinese Medicine, 2014, 23(5): 李建英, 路文盛, 刘斐, 等. 阿托伐他汀对早期糖尿病肾病老年患者外周血 NF-kB 和尿白蛋白排泄率的影响 [ J]. 实用医学杂志, 2011, 27(11): LI Jianying, LU Wensheng, LIU Fei, et al. Effect of atorvastatin on the activity of nuclear factor-kappa Bin peripheral blood mononuclear cells and urinary albumin excretion rate in elderly patients with early diabetic nephropathy[ J]. The Journal of Practical Medicine, 2011, 27(11): 宋薇, 赵玲, 温建炫, 等. 阿托伐他汀对早期糖尿病肾病炎症状

5 814 临床与病理杂志, 2016, 36(6) 态及尿微量白蛋白的影响 [ J]. 中国老年学杂志, 2013, 33(13): SONG Wei, ZHAO Ling, WEN Jianxuan, et al. Effect of atorvastatin on early diabetic nephropathy and urinary albumin excretion in patients with diabetic nephropathy[ J]. Chinese Journal of Gerontology, 2013, 33(13): 中华医学会糖尿病学分会. 中国 2 型糖尿病防治指南 [ J]. 中华医学杂志, 2008, 88(18): Chinese Medical Association Diabetes Branch. Guidelines for prevention and treatment of type 2 diabetes in China[ J]. National Medical Journal of China, 2008, 88(18): 郑筱萸. 中药新药临床研究指导原则 [S]. 北京 : 中国医药科技出版社, 2002: , ZHENG Xiaoyu. Guiding principle of clinical research on new drugs of traditional Chinese medicine[s]. Beijing: Chinese medical science and Technology Press, 2002: , 王玉红, 郭浩生. 益气养阴化瘀汤治疗早期糖尿病肾病 30 例疗效观察 [ J]. 河北中医, 2011, 33(8): WANG Yuhong, GUO Haosheng. Observation of Yiqiyangyinhuayu decoction on the treatment of early diabetic nephropathy[ J]. Hebei Journal of Traditional Chinese Medicine, 2011, 33(8): 张宁, 李同侠, 刘世巍, 等. 益气养阴活血法综合方案对糖尿病肾病患者尿微量蛋白排泄率及中远期疗效的影响 [ J]. 北京中医药大学学报, 2012, 35(3): , 216. ZHANG Ning, LI Tongxia, LIU Shiwei, et al. Influences of comprehensive therapy of replenishing qi, nourishing yin and activating blood circulation on urinary albumin excretion rate and middle-term and long-term curative effects in patients with diabetic nephropathy[ J]. Journal of Beijing University of Traditional Chinese Medicine, 2012, 35(3): , 张叶祥, 胡业彬, 姚淮芳, 等. 益气养阴活血解毒汤治疗糖尿病合并冠心病临床疗效及对 CRP HCY 水平的影响 [ J]. 中国中医急症, 2011, 20(8): , Zhang Yexiang, Hu Yebin, Yao Huaifang, et al. Effects of Yiqiyangyinghuoxuefiedu Decoction on the Clinical Effect. CRP and HCY in Patients with Diabetes Mellitus with Coronary Heart Disease[ J]. Journal of Emergency in Traditional Chinese Medicine, 2011, 20(8): , 李洁, 杨洪涛, 杨波, 等. 益气养阴活血通络法对糖尿病肾病 (Ⅲ 期 ) 中医证候及尿蛋白影响的研究 [ J]. 中国中西医结合肾病杂志, 2013, 14(3): LI Jie, YANG Hongtao, YANG Bo, et al. Supplementing qi and nourishing Yin, activating blood and collaterals on diabetic nephropathy (phase III) study of TCM syndrome and urinary protein influence[ J]. Chinese Journal of Integrated Traditional and Western Nephrology, 2013, 14(3): 林兰, 郭小舟, 李敏, 等. 早期糖尿病肾病尿蛋白排泄率相关因素及中医证型分析 [ J]. 中国中西医结合杂志, 2010, 30(9): LIN Lan, GUO Xiaozhou, LI Min, et Al. Analysis on relationship of Chinese medicine syndrome pattern with urinary albumin excretion rate and its related factors in early stage diabetic nephropathy[ J]. Chinese Journal of integrated traditional Chinese and Western Medicine, 2010, 30(9): 殷建, 欧妍. 阿托伐他汀对糖尿病肾病患者肾功能相关血清指标及肾脏纤维化的影响观察 [ J]. 河北医学, 2015,21(1): YIN Jian, OU Yan. The Influence of Atorvastatin for the Renal Function Related Serum Indexes and Renal Fibrosis of Patients with DN[ J]. Hebei Medicine, 2015, 21(1): 赵建明. 益气养阴活血汤治疗糖尿病性肾病蛋白尿 40 例 [ J]. 陕西中医, 2013, 34(9): ZHAO Jianming. Effect of Yiqi Yangyin Huoxue Decoction in the treatment of diabetic nephropathy proteinuria in 40 cases [ J]. Shaanxi Journal of Traditional Chinese Medicine, 2013, 34(9): 本文引用 : 贺学允, 陈玉玲. 益气养阴活血汤联合阿托伐他汀治疗气阴两虚兼血瘀型早期糖尿病肾病效果分析 [ J]. 临床与病理杂志, 2016, 36(6): doi: /j.issn Cite this article as: HE Xueyun, CHEN Yuling. Analysis of the effect of Yiqiyangyinhuoxue decoction combined with atorvastatin statin treatment of early diabetic nephropathy with Qi and Yin deficiency and blood stasis type[ J]. Journal of Clinical and Pathological Research, 2016, 36(6): doi: /j.issn

211 better than those in the control group, with significant difference between two groups (P < 0.05). The ocular hypertension of patients in the cont

211 better than those in the control group, with significant difference between two groups (P < 0.05). The ocular hypertension of patients in the cont 210 毛果芸香碱联合拉坦前列素治疗原发性急性闭角型青光眼的疗效观察符元党 1, 郑振优 2, 林再雄 2, 周吉良 1. 昌江黎族自治县中西医结合医院, 海南昌江 572700 2. 海南医学院附属医院眼科, 海南海口 570100 1 摘要 : 目的探讨